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Cited by 343COVID-19 and Mental HealthHealthcare professionals’ stress and burnoutOccupational Health and Burnout

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Investigating the Psychological Impact of COVID-19 among Healthcare Workers: A Meta-Analysis

Open access
Batra, Kavita, Singh, Tejinder Pal, Sharma, Manoj, Batra, Ravi, Schvaneveldt, Nena·2020·International Journal of Environmental Research and Public Health
DOI 10.3390/ijerph17239096PMC PMC7730003
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Abstract

Previous meta-analyses were conducted during the initial phases of the COVID-19 pandemic, which utilized a smaller pool of data. The current meta-analysis aims to provide additional (and updated) evidence related to the psychological impact among healthcare workers. The search strategy was developed by a medical librarian and bibliographical databases, including Medline, Embase, CINAHL, PsycINFO, and Scopus were searched for studies examining the impact of the COVID-19 pandemic on the psychological health of healthcare workers. Articles were screened by three reviewers. Heterogeneity among studies was assessed by I2 statistic. The random-effects model was utilized to obtain the pooled prevalence. A subgroup analysis by region, gender, quality of study, assessment methods, healthcare profession, and exposure was performed. Publication bias was assessed by Funnel plot and Egger linear regression test. Sixty-five studies met the inclusion criteria and the total sample constituted 79,437 participants. The pooled prevalence of anxiety, depression, stress, post-traumatic stress syndrome, insomnia, psychological distress, and burnout was 34.4%, 31.8%, 40.3%, 11.4%, 27.8%, 46.1%, and 37.4% respectively. The subgroup analysis indicated higher anxiety and depression prevalence among females, nurses, and frontline responders than males, doctors, and second-line healthcare workers. This study highlights the need for designing a targeted intervention to improve resilience and foster post-traumatic growth among frontline responders.

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Crossref · 10.3390/ijerph17239096

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Figures

Figure A1 Forest plot for the studies on the prevalence of insomnia among healthcare workers. The squares and horizontal lines correspond to the study-specific event (anxiety) rates and 95% confidence intervals (CIs). The diamond represents the pooled prevalence and 95% CI of the overall population. The overall pooled insomnia using a random effects DerSimonian-Laird method was 27.8% (95% CI: 21.4–35.3).
Figure A1 Forest plot for the studies on the prevalence of insomnia among healthcare workers. The squares and horizontal lines correspond to the study-specific event (anxiety) rates and 95% confidence intervals (CIs). The diamond represents the pooled prevalence and 95% CI of the overall population. The overall pooled insomnia using a random effects DerSimonian-Laird method was 27.8% (95% CI: 21.4–35.3).CC BY · PubMed Central
Figure A2 Forest plot for the studies on the prevalence of impaired sleep quality among healthcare workers. The squares and horizontal lines correspond to the study-specific event (anxiety) rates and 95% confidence intervals (CIs). The diamond represents the pooled prevalence and 95% CI of the overall population. The overall pooled impaired sleep quality using a random effects DerSimonian-Laird method was 64.3% (95% CI: 55.0–72.7).
Figure A2 Forest plot for the studies on the prevalence of impaired sleep quality among healthcare workers. The squares and horizontal lines correspond to the study-specific event (anxiety) rates and 95% confidence intervals (CIs). The diamond represents the pooled prevalence and 95% CI of the overall population. The overall pooled impaired sleep quality using a random effects DerSimonian-Laird method was 64.3% (95% CI: 55.0–72.7).CC BY · PubMed Central
Figure A3 Forest plot for the studies on the prevalence of Post-traumatic stress syndrome (PTSD) among healthcare workers. The squares and horizontal lines correspond to the study-specific event (anxiety) rates and 95% confidence intervals (CIs). The diamond represents the pooled prevalence and 95% CI of the overall population. The overall pooled PTSD using a random effects DerSimonian-Laird method was 11.4% (95% CI: 3.6–30.9).
Figure A3 Forest plot for the studies on the prevalence of Post-traumatic stress syndrome (PTSD) among healthcare workers. The squares and horizontal lines correspond to the study-specific event (anxiety) rates and 95% confidence intervals (CIs). The diamond represents the pooled prevalence and 95% CI of the overall population. The overall pooled PTSD using a random effects DerSimonian-Laird method was 11.4% (95% CI: 3.6–30.9).CC BY · PubMed Central
Figure A4 Forest plot for the studies on the prevalence of psychological distress among healthcare workers. The squares and horizontal lines correspond to the study-specific event (anxiety) rates and 95% confidence intervals (CIs). The diamond represents the pooled prevalence and 95% CI of the overall population. The overall pooled psychological distress using a random effects DerSimonian-Laird method was 46.1% (95% CI: 36.0–56.6).
Figure A4 Forest plot for the studies on the prevalence of psychological distress among healthcare workers. The squares and horizontal lines correspond to the study-specific event (anxiety) rates and 95% confidence intervals (CIs). The diamond represents the pooled prevalence and 95% CI of the overall population. The overall pooled psychological distress using a random effects DerSimonian-Laird method was 46.1% (95% CI: 36.0–56.6).CC BY · PubMed Central
Figure A5 Forest plot for the studies on the prevalence of burnout among healthcare workers. The squares and horizontal lines correspond to the study-specific event (anxiety) rates and 95% confidence intervals (CIz). The diamond represents the pooled prevalence and 95% CI of the overall population. The overall pooled burnout using a random effects DerSimonian-Laird method was 37.4% (95% CI: 14.8–67.2).
Figure A5 Forest plot for the studies on the prevalence of burnout among healthcare workers. The squares and horizontal lines correspond to the study-specific event (anxiety) rates and 95% confidence intervals (CIz). The diamond represents the pooled prevalence and 95% CI of the overall population. The overall pooled burnout using a random effects DerSimonian-Laird method was 37.4% (95% CI: 14.8–67.2).CC BY · PubMed Central
Figure A6 Funnel plot for studies on the prevalence of anxiety (Egger test: P = 0.15; Begg test: P = 0.90). The vertical solid line represents the summary effect estimates.
Figure A6 Funnel plot for studies on the prevalence of anxiety (Egger test: P = 0.15; Begg test: P = 0.90). The vertical solid line represents the summary effect estimates.CC BY · PubMed Central
Figure A7 Funnel plot for studies on the prevalence of depression (Egger test: P = 0.90; Begg test: P = 0.64). The vertical solid line represents the summary effect estimates.
Figure A7 Funnel plot for studies on the prevalence of depression (Egger test: P = 0.90; Begg test: P = 0.64). The vertical solid line represents the summary effect estimates.CC BY · PubMed Central
Figure A8 Funnel plot for studies on the prevalence of stress (Egger test: P = 0.69; Begg test: P = 0.86). The vertical solid line represents the summary effect estimates.
Figure A8 Funnel plot for studies on the prevalence of stress (Egger test: P = 0.69; Begg test: P = 0.86). The vertical solid line represents the summary effect estimates.CC BY · PubMed Central
Figure A9 Funnel plot for studies on the prevalence of insomnia (Egger test: P = 0.01; Begg test: P = 0.03). The vertical solid line represents the summary effect estimates.
Figure A9 Funnel plot for studies on the prevalence of insomnia (Egger test: P = 0.01; Begg test: P = 0.03). The vertical solid line represents the summary effect estimates.CC BY · PubMed Central
Figure A10 Funnel plot for studies on the prevalence of impaired sleep quality (Egger test: P = 0.22; Begg test: P = 0.22). The vertical solid line represents the summary effect estimates.
Figure A10 Funnel plot for studies on the prevalence of impaired sleep quality (Egger test: P = 0.22; Begg test: P = 0.22). The vertical solid line represents the summary effect estimates.CC BY · PubMed Central
Figure A11 Funnel plot for studies on the prevalence of PTSD (Egger test: P = 0.22; Begg test: P = 0.90). The vertical solid line represents the summary effect estimates.
Figure A11 Funnel plot for studies on the prevalence of PTSD (Egger test: P = 0.22; Begg test: P = 0.90). The vertical solid line represents the summary effect estimates.CC BY · PubMed Central
Figure A12 Funnel plot for studies on the prevalence of psychological distress (Egger test: P = 0.45; Begg test: P = 0.73). The vertical solid line represents the summary effect estimates.
Figure A12 Funnel plot for studies on the prevalence of psychological distress (Egger test: P = 0.45; Begg test: P = 0.73). The vertical solid line represents the summary effect estimates.CC BY · PubMed Central
Figure A13 Funnel plot for studies on the prevalence of burnout (Egger test: P = 0.47; Begg test: P = 0.60). The vertical solid line represents the summary effect estimates.
Figure A13 Funnel plot for studies on the prevalence of burnout (Egger test: P = 0.47; Begg test: P = 0.60). The vertical solid line represents the summary effect estimates.CC BY · PubMed Central
Figure 1 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) flow diagram detailing the disposition of screened, included, and excluded records.
Figure 1 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) flow diagram detailing the disposition of screened, included, and excluded records.CC BY · PubMed Central
Figure 2 Forest plot for the studies on the prevalence of anxiety among healthcare workers. The squares and horizontal lines correspond to the study-specific event (anxiety) rates and 95% confidence intervals (CIs). The diamond represents the pooled prevalence and 95% CIs of the overall population. The overall pooled anxiety using a random effects DerSimonian-Laird method was 34.4% (95% CI: 29.5–39.7).
Figure 2 Forest plot for the studies on the prevalence of anxiety among healthcare workers. The squares and horizontal lines correspond to the study-specific event (anxiety) rates and 95% confidence intervals (CIs). The diamond represents the pooled prevalence and 95% CIs of the overall population. The overall pooled anxiety using a random effects DerSimonian-Laird method was 34.4% (95% CI: 29.5–39.7).CC BY · PubMed Central
Figure 3 Forest plot for the studies on the prevalence of depression among healthcare workers. The squares and horizontal lines correspond to the study-specific event (anxiety) rates and 95% confidence intervals (CIs). The diamond represents the pooled prevalence and 95% CI of the overall population. The overall pooled depression using a random effects DerSimonian-Laird method was 31.8% (95% CI: 26.8–37.2).
Figure 3 Forest plot for the studies on the prevalence of depression among healthcare workers. The squares and horizontal lines correspond to the study-specific event (anxiety) rates and 95% confidence intervals (CIs). The diamond represents the pooled prevalence and 95% CI of the overall population. The overall pooled depression using a random effects DerSimonian-Laird method was 31.8% (95% CI: 26.8–37.2).CC BY · PubMed Central
Figure 4 Forest plot for the studies on the prevalence of stress among healthcare workers. The squares and horizontal lines correspond to the study-specific event (anxiety) rates and 95% confidence intervals (CIs). The diamond represents the pooled prevalence and 95% CIs of the overall population. The overall pooled stress using a random effects DerSimonian-Laird method was 40.3% (95% CI 31.4–50.0).
Figure 4 Forest plot for the studies on the prevalence of stress among healthcare workers. The squares and horizontal lines correspond to the study-specific event (anxiety) rates and 95% confidence intervals (CIs). The diamond represents the pooled prevalence and 95% CIs of the overall population. The overall pooled stress using a random effects DerSimonian-Laird method was 40.3% (95% CI 31.4–50.0).CC BY · PubMed Central

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Cites

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Research works printed but not linked: 2

  1. Nair, A.K.R., Chellaswamy, K.S., Kattula, D., Thavarajah, R., and Mohandoss, A.A. (2020). Perceived stress and psychological distress among indian endodontists during COVID-19 pandemic lockdown. MedRxiv.
  2. Higgins, J.P., and Green, S. (2011). Cochrane Handbook for Systematic Reviews of Interventions, John Wiley & Sons.

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Metadata

Authors
Batra, K., Singh, T. P., Sharma, M., Batra, R., & Schvaneveldt, N.
Affiliations
  • University of Nevada, Las Vegas (US)
  • University of Utah (US)
  • Department of Information Technology and Testing Center of Excellence, Coforge, Atlanta, GA 30338, USA
Corresponding author
Batra, Kavita
ORCID
Venue
International Journal of Environmental Research and Public Health
Publisher
MDPI AG
Published
2020-12-05
Volume
17
Issue
23
Pages
9096
ISSN
1660-4601 (ISSN-L)
DOI
10.3390/ijerph17239096
PMC
PMC7730003
OpenAlex
W3111432422
Cited by
342
References
107
Citations by year
2026: 9 · 2025: 30 · 2024: 36 · 2023: 86 · 2022: 108 · 2021: 73
FWCI
5.22
Type
journal article
Language
en
Open access
Licence
Locations
  • International Journal of Environmental Research and Public Health (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Digital Scholarship - UNLV (University of Nevada Reno) (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
Topics
  • Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
  • Health Sciences › Health Professions › General Health Professions › Healthcare professionals’ stress and burnout
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Occupational Health and Burnout
Keywords
COVID-19 pandemic, healthcare workers, psychological impact, anxiety, depression, stress, post-traumatic stress disorder, insomnia, psychological distress, burnout, nurses, gender differences, prevalence
MeSH terms
COVID-19, Anxiety, Depression, Female, Health Personnel, Humans, Male, Stress, Psychological, Pandemics

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